The Health Secretary, Sajid Javid, set out his vision for the future of the NHS yesterday. The full speech is available, and I have read it. This is my take on what he said.
First, he acknowledged that demand for healthcare is growing. As he noted:
At the start of this century, in 2000, health spending represented 27 percent of day-to-day public service spending. By 2024, it is set to account for 44 percent. This has been an acceleration of the trend in which the composition of the State has shifted towards health and care over the last 70 years.
To contextualise this he said:
I am a small-state conservative.
To this he added:
My vision of the State is one that is small but strong; empowering not constraining. But if the trajectory of the State continues unchecked, I don't believe it will be compatible with that vision.
In other words, the future will be characterised by health care cuts. That was the underlying message of yesterday.
How will this be achieved? His answer was threefold.
First, he is going to deliver prevention of ill health. This is going to be done via IT:
We're putting prevention at the heart of the NHS App, making it the front-door for preventive tools and services – like a new digital health check. And we're going to further develop the apps and websites that give people direct access to the diagnostics and therapies. That's the future.
Why is he doing this? Because, he says:
There is no small state which isn't a ‘pre-emptive state'. The NHS is significantly bigger than it would be if we had done a better job at preventing avoidable disease.
So, we are going to stop disease. Apparently, an app, rather than prevention of the sale of the appalling foodstuffs on which so many are dependent or the making available of lifestyles that are healthy by taking people out of poverty, will do this. This is almost on the Tony Blair scale of naive belief in the power of IT.
Second, he is going to require that we take personal responsibility for our health. He said:
In my party conference speech back in October, I talked about how we've got to recognise the power of families to make the difference when it comes to healthcare. Whether it's stopping drug addiction or dealing with depression, there's no more powerful motivating force than family. And again, there's no small state without strong families.
So, it's tough if you do not have a family to rely on.
And it's tough if you are a single parent.
What is more, it's tough if you are a child whose parents have to work and there's no one else around to care for you.
You'll just have to suffer it seems. The NHS of the future is being designed for the family that quite simply no longer exists, all of whose members are just sitting around waiting for someone to care for.
And what is more, it is one where we will all have personal care budgets to manage whilst doing this, which will apparently liberate us. Except they won't of course, because these budgets are rationing by any other name.
Third, he's going to use more IT. Well of course he is: every organisation is doing so. But it will not cut his costs by much. And people are not cared for by IT systems.
So what did we really get? A nightmare view of an NHS where:
- patient contact is limited,
- care is provided subject to struct personal budget constraints,
- where care is outsourced to families, whether or not you have one;
- and an app is the answer to all questions.
It takes considerable inability to come up with a package so far removed from need, and which the experience of experiments on all these issues has shown to be so undeliverable in reality. But that is what the Health Secretary is talking about, nonetheless.
If Javid wanted to set up the NHS to fail this is the speech he would have delivered.
And that is why I think he gave it.
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The picture that I see is an NHS increasingly turned to an emergency service and not one for routine care. Boiling frog syndrome suggests that we all are becoming habituated to very long waits for non critical interventions – cataracts, hips spring to mind but their are others. So 18 months for cataracts. If you don’t likeit, go private. Getting a GP appointment is starting to go this way as well.
I’m just reading the speech and despaired when I got to this, “As someone once said: ‘There is no such thing as public money, there is only taxpayers’ money.’ “
I forgot to use that one…..
Here is the whole quote, from Margaret Thatcher’s speech to Conservative Party Conference in 1983: https://www.margaretthatcher.org/document/105454
“Let us never forget this fundamental truth: the State has no source of money other than money which people earn themselves. If the State wishes to spend more it can do so only by borrowing your savings or by taxing you more. It is no good thinking that someone else will pay—that “someone else” is you. There is no such thing as public money; there is only taxpayers’ money.”
(Reading on that speech has echoes today, talking about the NHS, and jobs, and inflation, standing up to “Soviet suppression of freedom … 1953 East Germany, 1956 Hungary, 1961 the Berlin Wall, 1968 Czechoslovakia, 1979 Afghanistan, 1981 Poland, 1983 the South Korean civil airliner”. Today we would add Chechnya, and Georgia, and Syria, and Ukraine. And nuclear weapons.)
But that paragraph above gets the economics entirely back to front. Perhaps we can try something better:
“Let us never forget this fundamental truth: there is no source of money other than the State. If our State with its own currency wishes to spend more, it can do so simply by creating the money. There may be good reason to tax some of that new money back, but the State’s resources are not limited to taking money from its citizens: it literally prints the money. There is no such thing taxpayers’ money: it is all public money.”
Ultimately, it is all about priorities and distribution. The rest is bunk.
This is now going to the blog
Thank you
Watching Channel4 News (otherwise excellent) and their economics ‘expert’ Helia Ebrahimi, last night still trotting out the same conventional, tax and spend lines. Is there a single economic correspondent in the ‘MSM’, printed or broadcast, who gets that this might be a deeply ideological and flawed understanding? Or have they all been brainwashed by their economics ‘education’?
Also reading Diane Coyle’s latest book Cogs and Monsters, from someone who has some good insights and is not generally at the neoliberal end of the spectrum. However, it reads a bit like the economics equivalent of ‘greewashing’, suggesting that alls well, the economics academia has recognised its failings and has addressed them. So for instance, a bit of behavioural economics to recognise that maybe individuals are not perfectly informed rational actors after all. The models are all right really, not recognising the critiques of others that point to the need for profoundly different approaches such as agent based modelling and complexity – people like Steve Keen and the Santa Fe Institute.
Its going to be hard to challenge the died in the wool economic thinking out there (and I’d add some of the Soviet nostalgists to that list), until we have more people appearing in the media, teaching in academia and advising politicans.
Helia Ebrahimi was very disappointing last night
That was a very weak report – her charts did not even really to each other in any meaningful way
The MSN refuses to embrace MMT – or even understand QE (which is not the same thing, but related)
NHS & IT systems, a long record of unmitigated success, efficient and costs effective. Yes or No? Track & Trace anyone?
The vast majority of healthcare (80%?) is provided to the very old and the very young ie. those least likely to rely on apps.
Underneath it all is the privatisation of healthcare, the more apps, the less need for a universal Health Service and more control and profit for BigTech and BigPharma. Personal health budgets will move to the need for insurance to “top up”, then the budgets will be cut until insurance takes over and we’re all living in the USA.
Nightmarish indeed.
Track and Trace had NOTHING to do with the NHS – you have been well taken in as no doubt this lying Government intended . yes it was called NS track and trace but it was 100% outsourced and facilitated the lining of the pockets of Deloitte etc.
The only bit that did work was where the LA and Public Health did the tracing.
RichardB, trust me when I say that no way do you want to have a US style health system here. I know you already believe this. But how can we convince those who seem to either not understand the issue or are on the fence?
“But I hope you’ll forgive me if I avoid the usual soundbites”
Which he then, seconds later, reneged upon:
“For 73-years the NHS has had bipartisan support and – together with the monarchy – is one of this country’s most important and beloved institutions.”
Revisionist history must be a fun pastime for Tories.
First, he tries to take vicarious credit for the NHS’s creation and, second, draws equivalence between a successful socialist institution which is, quite literally, the lifeblood of a modern, functioning nation, and a parasitic, feudalistic anachronism mired in scandal. The gaslighting effort here is really rather admirable.
“I’ve now led six government departments, including one where I was responsible for the nation’s finances, and this one – the highest spending department. I’ve seen first-hand how – when healthcare takes up an ever-greater share of national income, you have to make some serious trade-offs on everything from education to infrastructure.”
What starts as a humble brag about his experience descends into a nonsensical ‘argument’ (I use that word in the loosest possible sense) for austerity. His promiscuous relationship with employment is not a virtue in this regard. And we know the ‘difficult choices’ line is provably false.
“As someone once said: ‘There is no such thing as public money, there is only taxpayers’ money.’”
I thought you weren’t doing the soundbites, Saj? Convenient of you to omit Thatcher’s name from that particular quotation. And it appears the irony is completely lost on you that the industry from which you came (as head of a division of derivatives trading for Deutsche Bank, no less), which crashed the global economy in 2008-9, did indeed prove that there was ‘public money’ but it just shouldn’t have been created and funnelled to shore up that morally bankrupt profession.
How can we sum this all up in a headline?:
Former derivatives trader notionally in charge of nation’s health says we can’t afford nice things.
You put it well
Sajid Javid says that spending on the NHS will have increased from 27% to 44% between 2000 and 2024, the inference being that all spending has been increasing, just that NHS spending has increased more. However, when he introduced the austerity agenda in 2010, George Osborne insisted that NHS spending will be ‘ring fenced’ so increasing at a faster rate than non ring fenced areas, which would greatly influence any increased imbalance in the NHS spend as a % of total public spending. This ring fencing was confirmed by the Kings Fund who stated that during the period 2010 – 2020, NHS funding had increased at a rate of 1.8% p.a. They went on to point out that this compares unfavourably with pre 2010 increases of 3.7%. By my rough calculation that cumulative reduction in increases will have amounted to £30billion p.a. by 2020. That reduction in funding should be set against inflation over the period plus a population increase of 2.5%, so a substantial real-terms loss.
If that’s the state of the ‘ring fenced’ NHS, imagine how much non ring fenced services are now suffering.
Thank you
As inconvenient as it might be, the King’s fund data shows that spending on the NHS has increased in real terms, even when population increases are taken account.
I’m surprised you didn’t point that out!
And you ignored the fact that healthcare has become much more complex, and so more expensive, meaning your simple stat is nonsense.
But I suspect you knew that, because you’re a troll.
Well, we’re all so scared of events in the East some of us will find anything acceptable these days.
None of this will stop them getting on with what they wanted to do since 2010. Nothing has changed really.
And I’m sure that money you’ve been talking about elsewhere will be finding its way into private medical care investment so that the rich can make hay out of other’s health problems – perfect!
Once again the coincidentals here with oil, wealth, the environment and war just seem to stack up nicely for a species who are on the way out.
Us. We’re on the way out, and some of us will be making themselves rich as we do so.
In the US, where private medical care is the only option, funded by extortionate insurance contributions, medicare for all is a popular policy supported by a large majority of both Republican and Democrat party voters. The hold that the insurance companies have by their election fund contributions that prop up their corrupt political system is shameful. We lose the NHS here at our peril in the hands of continuing austerity policies of the Tories.
Whether there is any public health care option depends on which state you are in. Unfortunately, most states have virtually none, except for possibly the homeless and certain trauma cases.
Because I think that health in old age has much to do with how people have had to live in the first part of their lives I am always sceptical about politicians who talk about the cost of the NHS without ever relating avoidable illness to its causes. i.e, Poverty, stress, bad food, bad employers, bad housing, etc, etc.
Back in the 1960s I lived in a village and delivered newspapers to a new, small council housing development, thoughtfully designed to be a mixture of buildings, some suitable for families with children and some suitable for the over fifties or pensioners.
I moved away but frequent visits back to my family meant that I was kept up to date with what turned out to be a very successful community within a community. All of the original elderly habitants are now dead but despite most being born before the first world war and having suffered all kind of hardship, thirty five years of intelligent post WW2 government meant that nearly all lived well into their eighties with a minimal degree of medical or home help intervention.
Essentially, bad government kills people and costs far more than doing things intelligently.
Agreed
And thank you
Mr Langston,
“Essentially, bad government kills people and costs far more than doing things intelligently.”
A great deal said, very succinctly. Hat tip.
The other thing bad Government does is create markets of exploitation that charge them handsomely for services as well as kill people . What ‘costs more’ is profit for the private sector. It is well known that the U.S. ‘health’ system is one that promotes procedures – many unnecessary – chasing fees rather than a cure. This happened to Tim Snyder recently and is detailed in his book ‘Our Malady’. I mean just look at the man in his latest blogs. I can’t believe he’s 4 year’s younger than me. He’s been through the wringer – and it’s debateable what was worse – his condition or his ‘treatment’.
Well said. The first house I bought, in Battersea built in 1873 long before gentrification, was in a similar community, with a mix of housing types, built then for working class people, with a school and amenities included. Now mostly owned by Peabody (housing association) but sadly has been steadily sold off.
Ive often reflect back on it and how the idea of building communities is not new. A mile North across the railway is a collection of 1960s tower blocks. My wife was a social worker and you can guess which area was the most problematic.
The cynic in me wonders if the whizzo plan to deal with the increasing expense caused by our aging population is simply to try and stop it aging so much? Only in certain income groups, of course.
It would certainly explain some of the policy we’ve seen since 2010 and the recent life expectancy forecasts would tend to indicate it is working.
Heck, to be doubly-cynical, you could say that much of the pandemic response was just a continuation of said policies. Isolate if you’re at risk (and can afford it), work from home (if you’ve got the right sort of job), ‘Covid is now endemic’ and so on.
Earlier tonight I was on a zoom call for long covid. It appears to have been forgotten about. It’s the next pandemic, the number of people who are affected by it in all age ranges. However, I had to ask them on there what about pensioners? We suffer from it too.
If Javid wants to start doing something about prevention, he could start thinking about long covid.
I missed the first 15 minutes because I had fallen asleep. Long covid, I think, although nobody up here cares enough to do any research.
In the meantime, https://sosnhs.org/demands/
It is my big concern because it is life-changing, and impacts all ages
Adding to Riuchard’s comment, covid appears to affect the brain in certain ways, but the long term effects need more research. Even more reason to deal with it properly, one would have thought. Not this gang of idiots, it seems.
For those who have not come across him, I’d recommend Roy Lilley’s regular blog on the NHS. Someone who knows about the NHS from the inside and really cares. His latest is scathing about Javid.
I’ve also met him and he is a thoroughly nice guy.
https://myemail.constantcontact.com/Potatoes.html?soid=1102665899193&aid=rKWvAazwsco
I have also met him and second the opinion
Thank you Robin.
I tried and failed to obtain a meaningful estimate of the employment that health funding provided in 2000 and 2021.
Yes, with an aging population, UK is going to need more health care. Good, we can provide quality employment for more people, who will buy stuff and services and help the economy revolve.
Javid grumbles about the expenditure, he does not acknowledge the double benefit, of improvement in quality of life for those treated and those providing it.
Am I mistaken?
You are correct
Whatever we are going to do, worth pointing out that Medical Staff are a very finite resource.
Like you I am married to a Medic, in my case a Dental Nurse, in yours GP but it takes a long time to convert a school leaver to a Doctor, Nurse etc
What we certainly are not doing is making sure that we keep our medical staff and making the best use of them. Let alone trying to address some of the drivers of avoidable ill health, the price and availability of alcohol being an obvious starting point.
Agreed
Javid clearly reads too many I.T. fairy stories.
My partner’s sister is obese and has an interesting range of disorders most of which boil down to: a failure to get out of bed and take regular exercise. For this to happen, there would need to be some form of local authority intervention to get this person back into a reasonable set of non-self-destructive habits.
Sadly, I.T. ……Javid’s sugar plum fairy ……will not deliver the goods in this case & plenty of others (GPs are excellent for giving advice to people – provided they follow it – many don’t some are incapable of doing so – the case in this case). Given the tory destruction of local government, it is unlikely that my partners sister will get the help that she needs – over the time frame that is needed (months if not years).
My partner had to go private to get the shrinks to take a look at her sister and analyse what was wrong (not that much but enough to cause the problems outlined). Key point: prevention is always batter than cure – and Javid has a point wrt that – but prevention usually needs a boots on the ground approach which sadly he is either incapable of understanding or – prefers not to understand cos, after all – that would mean spending money. & we can’t have that in the oligarch-dominated UK-Oblast – can we?
For the curious: you can look till you are pink in the face – you will never link me to my partner or her sister.
I agree entirely
The idea that an app can tackle a mental health issue is almost absurd
Even to get a person to use mindfulness, CBT or zero to 5k as apps requires a lot of gentle persuasion first
The Javid logic simply denies that reality
The single biggest driver of poor health is Poverty. This speech makes this connection while attempting to pretend there is no connection when he says:
“More than that, we must close another gap: the almost 20-year difference in healthy life expectancy between the richest and the poorest amongst us. That is completely unacceptable.”
Close the financial gap between the richest and the poorest and the closing of the life expectancy gap also happens. While it annoys the hell out of a lot of people – for both good and bad reasons – the single biggest cause of Poverty is lack of money.
The strategy of prevention announced is, largely, the same UNUM inspired strategy of prevention that has been imposed onto the DWP over the last decade or so. A targets culture in which the metric of ‘success’ is having people cease to claim benefits. This is a recipe for social murder: raising the death rate among specific social groups as a result of policy. The Disabled have been at the cutting edge of that approach to policy since 2010. The outcome has been a hotly contended rise in excess deaths among Benefits Claimants. The strategy of prevention announced by the Minister simply extends that approach to the NHS from the DWP. The strategy of prevention has the same underpinning worldview as the Prevent Strategy for radicalisation in schools: address only what is visible and make it invisible.
“But it’s just as important we prevent new people from joining waiting lists, by putting as much effort as we can in keeping people well, before they get ill. The irrefutable logic is to act now, to stop risks and costs building up in the future.”
The Minister has zero idea of what queues are. In every Queue there is a Waiting Line and a Server. The stratgy of preventing new people from joining the Waiting Line does nothing to improve the quality of the intervention delivered by the Server. A short Waiting Line attached to a poor quality Server continues to give a poor quality Service. The ‘irrefutable logic’ addresses exactly one thing: the frequency of people joining the Waiting Line. It does not address the Quality of Service of the Queue as the holistic entity it is. It does not address the very real, evidence based, observation that a best practice to avoid a long Waiting Line is to have multiple Servers with redundancy. That would translate to having extra Nurses, extra Doctors, extra Hospitals, extra Clinics, and People within the NHS waiting for Patients and not the other way around. It is a controversial idea because it is not ‘efficient’ or ‘value for money’. The Speech, in terms of organisations and structures of delivery, fetishises queues and makes them the sole source of metrics for ‘success’. Which is pretty much the same thing as was done with the DWP – especially around Disability.
The Health-App ‘solution’ is concerning for two reasons. First: Health-Apps are nothing more than a Waiting Line management mechanism. The same as calling a Call Centre. My intuition would be to investigate which Tory MPs have shares in Call Centres or Software Developers – or worse, ‘Digital Agencies’ – because the Call Centre based structural logic leads to subscription based solutions. Apps make their money on subscriptions. Uber is, effectively, a conveyor belt towards a subscription for transport through the use of a meter. Uber makes no secret that the long term aim is to have automated vehicles that people subscribe to and can hail when required. It is not a subscription in the same sense as your ‘Trout and Carp Magazine’ Subscription. It is more of a rent on participation in the Waiting Line. The second reason follows on from this rental model: the outcome is that all interactions with the Health-App are not only metered but rationed. In the same way as the DWP rations benefits to Claimants who qualify for benefits by lacing obstacles in the way of obtaining benefits. The way to avoid rationing is to get into a Queue where there is no rationing. That Queue might be a Waiting Line that connects to the same Server but, because you pay the Rent – go Private – you get the Service. The App is little more than a Rental Portal.
Which is, long term, only going to cause a decline in Life Expectancy. The evidence for this ‘wild’ claim is that of the American Healthcare System where money buys access to Waiting Lines at all stages of a Patient’s interaction with the System. Call Centres were set up in the 1980s, by IT Departments to ration scarce skills. It resulted in a multi-billion pound global industry where the bill for rationing skill was footed by the Customer as a direct substitution for actually paying to develop skills. This is the outcome for the NHS. It is Call Centre Healthcare. Which will, inevitably, come with all of those Call Centre Scams.
The Prevention Strategy is nothing more than building cashflows from Patients to App to support Lifelong Rental of Health.
Finally:
“I’m also excited by what the future holds for vaccination. Last month I was in Cambridge, Massachusetts to hear about some of the pioneering work in mRNA technology – something that was previously regarded as too experimental, but came to save tens of thousands of lives in the pandemic. Such technology offers hope on everything from HIV to malaria and will be a key part of our prevention agenda in the years to come.”
He did not need to travel to Cambridge, Massachussets to hear about mRNA technologies. The UK used to be a leader in this. Had he invested in UK Research since 2015, it would continue to be a leader. This is the pinnacle of Lifelong Health Rental: everything is outsourced to the highest profit margin.
Thank you
And much to think about
A colleague made a blindingly obvious point that the biggest trigger preventable trigger for mental health problems is money problems, yet we have a Government intent on impoverishing us all.
The best mental health medicine is cash.
Absolutely right
I’ll second that – the only one saving grace of David Cameron was that he mentioned happiness as a measure of the good society but then having got the sound bite he of course went no further.
I agree about a move towards a proactive health service, but not Javid’s version.
I remember a few years back there was a hit peice in The Daily Mail about £££’s being spent on showing the elderly how to put slippers on, there was, naturally, more to it than that, but it shows how any attempt at proactivity is treated by most of the British Media.
Family member recently went for minor day surgery in Scotland. Two notable aspects:
1) Arranged by NHS, in an NHS hospital, but outsourced to a private clinical serves provider, Medinet. Staff (nurses, anaesthetist, surgeon, etc) all NHS doing “overtime” ie contracted privately, on a Sunday. Medinet margin in last accounts 35%, ultimately owned (Medinet Topco) in tax haven (CI).
2) patient not given proper prep materials – turned out was expected to bring slippers, dressing gown,etc – but no paperwork stating that. Sent home without instructions on how to care for wound / probably more missing paperwork.
This is the future – NHS an insurer that isn’t responsible for quality, and with coverage probably as you say to a fixed budget.
We need to fight if we want to restore a universal public service, but not clear how. No point protesting, they don’t listen. The regime needs got rid of.
What about suing?
The fixed budget has already been introduced. The “Integrated Care Service” is the trojan horse. Fixed budget and for a registered population. No obligation to provide comprehensive care, and if you live in the area but are not registered – homeless, just moved, any number of reasons – you will not be covered. Very soon the criteria for who is covered will get tightened and more and more will have to go private.
https://lowdownnhs.info/comment/javids-new-ideas-short-on-funding/
Weownit has given up on trying to persuade the government and the house of lords to amend the health and social care bill. They suggest that anyone who wants change has to get in touch with their local health board or ICS and get a promise that they will not allow private companies like Virgincare on the boards.
By the way, this thread was linked to on the lunchtime call today on weownit. Not by me, so someone else must read both, too.
We must challenge the narrative of “healthcare spending taking an ever increasing share of spending – it can’t go on”.
It can and should go on.
When Sajid Javid says that the share of spending on health has risen from 27% to 44% over the last 25 or so years he implies that other important spending needs have been neglected because of our profligate spending on health.
Nonsense.
It is natural that improved treatments and an aging population should mean more money spent on health. Furthermore, if we assume trend real GDP growth of 1% and if we choose to spend half of that increasing wealth on health then that would imply 5% real increases in the health budget each and every year. These are perfectly reasonable numbers – indeed, we could do more but the point is that 5% on NHS budgets should be the baseline long term annual increase (with additional money front loaded now to stabilise things).
Increasing health spending is not done at the expense of everything else (…and that is before I get on my MMT high horse!!).
Agreed
The most disgusting bit is that the Government has records of birthrates over the years and must have known that there would be a boom in elderly eventually and having agreed to provide an NHS should have anticipated it and just funded the need instead.
This false narrative of being ‘caught by surprise’ is what really makes me angry about NHS under the Tories and with the Tories themselves.
I do not have any humanity towards them I’m afraid – not on this issue – because their objectives are truly obnoxious.
We must challenge this pretence of ‘hopelessness’ that they are peddling. Where is HM opposition on this?
Why oh why can’t the average person see beyond their lies?
I wish I could answer that
But I cannot explain soap operas either
Agree, Richard. And PSR, I am afraid that I have to agree with Angela Raynor’s comment about the Tories. It fits with your feelings, and mine, about them.
forgive me for adding my version of what is going on here:
1. he is distancing himself from the health and social care bill , which lacks a convincing rationale, and which is struggling to get through Parliament despite a huge majority. By moving on he is signalling it was not me , and I was told by the Prime Minister to do it.
2. He is bidding for the status of thought leadership. Its a poor stab and his speech writer is taking the piss. How else would all his references start with the letter B. What can it mean? Bollocks is the only word I can think of. As for the reference to the numbers of old people rising faster than ever before I think he will find that people are getting older at exactly the same rate as they always have done. He obviously doesn’t read his own speeches.
3. But he has such a low opinion of his own party he seems to believe that it will be enough to get him onto the shortlist for the leadership race, which cannot be far away.
4. This is in the same territory identified by Jon Ronson in “Staring at Goats”. If you will it hard enough and cite the neo-liberal signifiers of choice and freedom ; and be prepared to lie by claiming fealty to both the NHS and the small state he expects to get on the short list.
5. It also claims the mantle of the executive pre-empting the democratic process. He seeks to prejudge any covid inquiry, not be accountable for delivering the law but is already moving beyond that , and is claiming that Leadership demands this. His model is the military as described so well in the recent edition of the LRB.https://www.lrb.co.uk/the-paper/v44/n05/simon-akam/a-surfeit-of-rank
5. He obviously doesn’t expect to be around to deliver any of this contradictory and pious nonsense. If Rishi gets the job he would hope to move back to the Treasury in any case.
Much to agree with, but I found Thatcher too, and she is not a B, in that sense
Thatcher is an honorary B, in the traditional sense.
You may also like this on the american military leadership tradition which he obviously subscribes to :
.https://www.lrb.co.uk/the-paper/v44/n04/laleh-khalili/stupid-questions
The U.K. government is within a whisker of being a socialised health system with a government attached. If you include care, then we are already there.
NHS spending has gone up in real terms every single year (except last year as the 2020 special covid funding rolled off, though that is normally not included in the stats as it wasn’t part of the NHS budget)
But I’ve been through this argument with the ‘moar moneh’ crowd. They ultimately and reluctantly concede the point but then claim we shouldn’t be looking at real terms spending or % of GDP spending, but instead look at *demand* which is rising quicker due to the aging population and medical innovation.
I think it’s something the general public never really understood – ‘austeriteee’ did exist in terms of departmental budgets (police, defence etc), outside of health and – weirdly – international development.
But there never was any austerity in total government spending; all those cuts just provided room for increased NHS, pensions and benefits spending (so-called annually managed expenditures that exist outside of departmental budgets).
We have prostrated ourselves to serve the elderly. Maybe that was right, maybe wrong. But it certainly was expensive and a trend that cannot be sustained indefinitely.
So what are you saying?
Is a cull of the elderly your option of choice?
If not, how else do you think those who have no more props[etc of saving are going to be care for?
Details please because you must know the answer based on what you said
Well you for example will presumably pay to see a dentist or optician or vet for your dog. You can afford to pay towards healthcare, many can. The health service should make a charge for those who can afford it, not at the rates of private health care but there is a middle ground.. people will be up in arms because they are used to it being free. But the current system is unsustainable
You know that US healthcare costs twice as much as ours because in no small part of the adm8n
You want to do the same?
So tell me, how would you impose this tax fairly, because that is all that you are proposing, after all?
Wouldn’t progressive tax be easier?
Good Lord Carl – More Money’!!! Pah! What money? It’s been in decline since 2010! And what about when the Tories have been in power before that?
Where have you been? Asleep?
Anyone who has read ‘The Five Giants: A Biography of the Welfare State’ by Nicholas Timmins (1995) – a book that even that arch Neo-lib dalek John Redwood thought to be rather good – knows that as soon as it was created, worries about funding the NHS at Westminster have been a fact of life.
That fact of life got worse however when some bint from Grantham (sorry Richard) decided to rewrite the laws of fiscal history and proclaim that there was no such thing as Government money and that it was only tax payer’s money instead.
Society decided to swallow that whole even though it was the biggest load of tripe ever – as has been tossed around on this most worthy blog time and time again.
The difference between nature and human society, is that instead of leaving the elderly, weak and poorly to become someone’s dinner, we decided to look after each other. Or so it was.
In his book, Timmins is praised for for bringing the personalities of people like Beveridge , Bevan and Butler alive who helped make the NHS and social security (I hate the phrase ‘welfare state’) a reality.
How I wish we had ‘can do’ people like that now.
The only ‘can do’ attitudes we have now in Parliament are to do with fucking things up I warrant you. And for personal gain – I bet Javed ends up on some health care provider Board one day on a nice little earner as a ‘special advisor’.
The bottom line Carl is that we can afford anything really. Did you know that? As Timmins points out, it is just a matter of will that NHS came about. Will, backed by morality leading to choices.
The next thing you’ll be saying is that is was unsustainable and it helped cause inflation when in fact that was never the case – the inflation in the 1970’s was caused by a set of unique factors – the Arab/Israeli conflict where the West was punished for its support of Israel by Muslim oil producing countries with higher oil costs; the loss of the gold standard to be replaced by money markets valuing currencies and the advance of globalised finance to name but a few.
Every economist I’ve ever spoken too has told me that welfare/social security payments – even the more generous ones – do not cause inflation.
More money? Huh – I tell you what – lets have the RIGHT AMOUNT of money for the services we need for once. That would be something.
Health spending has the highest multiplier in most estimates
On sustainability of funding:
1.The UK spends less than the major northern EU countries . It likes to compare to the EU average which includes a lot of poorer countries.
2. It spends much less than the USA. No one ever says that that system is unsustainable.
3. Demographic pressures will recede once the baby boomers go through.
4. The electorate vote for their priorities. As more voters age they will support the prioritisation of health and social care.
5. Spending on health and social care is better for the domestic economy than other competing priorities e.g. military spending. It creates jobs, useful output , and user satisfaction – as opposed to financial services, the building/mortgage industry and consumer goods retailing etc.
6. All previous attempts to paint rising healthcare expenditure as bad, dangerous and unsustainable have been proven to be wrong.
7. One of the biggest and fastest growing industries worldwide is healthcare and the UK benefits from being a leader in pharmaceuticals and biotechnology.
8. There is no shortage of bright young people who would like the opportunity for medical training. Massive expansion would boost supply and reduce prices. But be unpopular with doctors.
9. Medical productivity is linked to investment. Its the restriction on investment that has held the NHS back.
Conclusion: Increased spending on health and social care in a comprehensive and universal system is neither unsustainable nor unaffordable. Just unpopular with doctors (who benefit from the current system of shortages) and proponents of the market as the solution to all problems.
Thanks
I’d agree with all of that except for the critique of doctors. Whether GPs or registrars or NHS consultants, my sense (and from the ones I know) is that they are mostly working stupid hours under unsustainable pressures. Not good for them or us. Surprising that even more of them don’t jump ship to the private sector where they could work shorter hours and earn a lot more. Some of course try to have it both ways and yes there will be exceptions.
As well as the contrast in GDP%age spent on health, one can compare numbers of doctors, nurses and hospital beds where again the UK is well behind. Figures that are easier perhaps for the public to understand. Even Jeremy Hunt is on the case that without significant increases to staff numbers, nothing much will change. Having worked at lot around the technology sector, I learnt decades ago that technology is never a silver bullet. Javid reveals his ignorance and naivety with his claims on that front.
Of course there are areas where the NHS could do things differently and better – getting the very best practice of some areas into those that lag behind. Thats a potential huge strength of a nationalised service which fragmented private systems do not have. Breaking down some of the barriers between departments – the old consultant baronies – and treating the whole patient. Roy Lilley is good on these. However, making change happen in organisations that are already under acute stress is next to impossible. You need a degree of spare capacity to support the changes.
Another hugely important area which would help the NHS enormously is the appalling state of health of the nation – prevention rather than cure. That is massively under-resourced and improving the health of people will reduce the load on the NHS. Cynics will of course point out that the pharmaceutical and food industries have a vested interest in our being unhealthy.
Much to agree with
The reason for the shortage of doctors is due to the £9000 loan does not cover the cost of training and the government is so mean that it severely limits the number of places. The UK is still, after many years been poaching trained doctors from 3rd work countries. Nursing used to be an on the job training course but Tony made it a university course.
Knowing corporate management I suggest the best way to save money in the NHS is to cut the number of managers with the aim of putting experienced doctors. I am a mining engineer and the is as far as I know still a statutory requirement for a mining engineer to be the in charge of a mine. There is no substitute for someone knowing the consequences of his actions.
800 new NHS medical graduates have not been offered jobs this year so far because of government cuts
In 2013 I was in hospital for a month which included the day that the Lansley reforms came in – April 1st, believe it or not. When I asked the staff on the ward about it, they knew nothing about it, but said that that was probably why the headed notepaper had changed.
Last year when I was in for 3 weeks in September, about half the nursing staff were talking about going private or leaving nursing altogether. That’s how much morale has changed under this government, all intentional, I would think.
Very likely intentional, I suspect
To Robin,
I was merely pointing out that doctors are staunch supporters of the two tier system and the training regime that ensures a shortage of doctors and high fees for their services.
The simple solution of training more doctors and ensuring the NHS had sufficient capacity to meet demand is too readily dismissed as unaffordable and unsupportable.
UK Doctors total earnings are high by international standards, in general . The example of orthopaedic surgeons who reacted to increased numbers by reducing productivity shows where the problems lie.
I am not convinced there is any current evidence for your claim
I think thos may been true
The world has moved on and this seems like legend but not fact to me now
Unless you can prove me wrong, and if so I will stand corrected
75% 0f NHS male consultants work in the private sector.
I will send you a copy of a comparison of earnings from ten years ago.
The fact that it is difficult to know up to date earnings tells its own story.
Consultants continue to prefer to work the way they do because they do not want to dilute their earnings by expanding their numbers.
The history of this was written up by David G Green several years ago for the USA where it applies even more so.
Doctors are not wholly responsible for the system but they have shaped its current form in a compromise with politicians keen to reduce the public sector.
I think your data is seriously out of date
It relates to pre 2010